I’ve been inspired by a recent New York Times article that came out about IUDs, better known as intrauterine devices, and how painful and horrible some of the experiences for women have been over the years. Since writing some of these thoughts, I saw that a Cosmopolitan article recently chimed in on the topic. I figured it was time for me, as a medical professional, to share my thoughts on how I’ve managed my patients with IUDs; our experiences together, for the large majority of cases, have been positive.

As a disclaimer, I don’t have personal experience with IUDs, meaning I’ve never used them. However, in clinical practice, I was the only person in our clinic who placed them, removed them, and managed them for 15 years. So, I’m very aware of the benefits, risks, side effects, and discomfort that can often come from placement, having them, and then from their removal.

Also, as a disclaimer, although I am a board-certified family physician, I am not your family physician, meaning any questions or concerns that you have about your own personal experiences, please make sure to talk with your primary care provider. Lastly, I’m not here to promote or advertise on behalf of any particular brand of birth control or IUD. I will be saying some names of specific ones that I know that I have used and have placed for patients, but I’m in no way an ambassador for any of these brands. So, please check with your providers if you have specific questions.

Let’s start with the speculum. They come in all shapes and sizes. Some are metal, and some are plastic and disposable. Most women are very familiar with what they are used for, especially those over the age of 21. This is what helps with our well-women exams, gynecologic exams, pap smears, biopsies, and placements of things.

IUDs, in general, are used for birth control. They’ve been used widely since the 1950s, starting with the non-hormonal copper IUD. It has since gone through multiple variations, where either it is copper and does not contain any medication, or it is a brand that contains a certain type of medication to help prevent conception, heavy or painful periods, or uterine conditions like fibroids. Over the years, it’s become a little bit more popular, I believe, because of its hands-off approach to contraception, meaning you go in, the procedure, your doctor puts it in, and you don’t have to manage anything for the most part. You don’t have to remember to take a pill every day or get a shot every three months. Most of them last anywhere from two years up to 10 to 12.

That decision depends largely on preference. Each patient decides if she wants to include hormones or not and if and when you’re thinking of conceiving and having children. As you get closer to your 40s, you decide how long you want to keep it and how long you want to rely on something that is exogenous or outside of your body’s normal hormonal process and when to coast into menopause. If you’re older in age, going towards the perimenopausal and menopausal phase of life, you may want to think about the risks of osteoporosis. The longer that your normal hormonal cycle is interrupted, particularly with lower estrogen, which these IUDs can contribute to, the higher risk you may be at risk for low bone density.

There are many different things you should bring up with your provider when you’re talking about the different options and what your choices are. Generally speaking, the use of IUDs is very safe, meaning there are not many reasons why a woman couldn’t choose to have an IUD. I can’t think of why most women could not use a copper form of an IUD, particularly because they are non-hormonal unless there is an actual allergy to copper.

The ones that contain progesterone, like Mirena and Kyleena, are also available unless you have a history of an allergy to that hormone, a history of a certain type of cancer, or a predisposition to a certain type of cancer that is stimulated by progesterone. If that’s the case, you will need to avoid them.

The great news about IUDs is not only their hands-off approach, as long as you don’t have any complications, but also that they’re fairly easy to remove by your medical provider once you’re ready.

I know some people have talked about removing it on their own at home, and even some of my medical colleagues have done their own removals. However, I wouldn’t recommend that when she could come back and do the procedure. I would prescribe two things that day: ibuprofen and Cytotec.

I would prescribe the 800 mg dose of ibuprofen to be taken about an hour before they came in for their appointment, and then they had a couple left over for the days after placement for potential cramping and pain and all that. The second medicine, Cytotec, is one you might have heard of being used in labor and delivery when it’s time to have babies. It helps with the induction of labor and is a prostaglandin inhibitor that helps the cervix, which is a doughnut-shaped exit when it comes to the delivery of the end of the uterus. Normally, it is closed, or in some women, it may have a fingertip opening. Cytotec helps to loosen up that opening and dilate it a little bit so you can slide, insert, and leave the IUD in the uterus.

It can be used intravaginally or orally, but for an IUD placement, I would prescribe it to be taken orally. I would have ladies take it three hours before they arrive because I want that cervix to be nice and relaxed and have a little bit of dilation–like a fingertip to one centimeter. The other thing you could do, either along with the pre-medication or instead, is to schedule placement during the last couple of days of their menstrual cycle. The cervix is slightly dilated during that time, as well.

These are three of the biggest steps prior to coming to your visit that make the day of the procedure significantly more comfortable and significantly less painful and crampy. There is less pushing and pulling and prodding during the procedure and much more ease when it comes to the provider being able to kind of place things much more comfortably. And I think those things are probably the biggest things that a lot of women have not had the option to do, or maybe some providers weren’t trained to do it that way.

C. Nicole Swiner is a family physician.